Article

Usefulness of the Neutrophil-to-Lymphocyte Ratio in Predicting Short- and Long-Term Mortality in Breast Cancer Patients

Department of Internal Medicine, Staten Island University Hospital, Staten Island, NY, USA.
Annals of Surgical Oncology (Impact Factor: 3.93). 06/2011; 19(1):217-24. DOI: 10.1245/s10434-011-1814-0
Source: PubMed

ABSTRACT

The neutrophil-to-lymphocyte ratio (NLR) is a strong predictor of mortality in patients with colorectal, gastric, hepatocellular, pancreatic, and lung cancer. To date, the utility of NLR to predict mortality in breast cancer patients has not been studied. Therefore, the aim of our study was to determine whether the NLR is predictive of short- and long-term mortality in breast cancer patients.
Our observational study used an unselected cohort of breast cancer patients treated at the Staten Island University Hospital between January 2004 and December 2006. A total of 316 patients had a differential leukocyte count recorded prior to chemotherapy. Survival status was retrieved from our cancer registry and Social Security death index. Survival analysis, stratified by NLR quartiles, was used to evaluate the predictive value of NLR.
Patients in the highest NLR quartile (NLR > 3.3) had higher 1-year (16% vs 0%) and 5-year (44% vs 13%) mortality rates compared with those in the lowest quartile (NLR < 1.8) (P < .0001). Those in the highest NLR quartile were statistically significantly older and had more advanced stages of cancer. After adjusting for the factors affecting the mortality and/or NLR (using two multivariate models), NLR level > 3.3 remained an independent significant predictor of mortality in both models (hazard ratio 3.13, P = .01) (hazard ratio 4.09, P = .002).
NLR is an independent predictor of short- and long-term mortality in breast cancer patients with NLR > 3.3. We suggest prospective studies to evaluate the NLR as a simple prognostic test for breast cancer.

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    • "On the other hand, because the NLR is significantly associated with the pathological response to preoperative chemoradiotherapy , the difference in the survival rate in DFS may be partly explained by differences in the treatment response to preoperative chemoradiotherapy between the low and high NLR groups. Consistent with our results, it has been reported that an elevated NLR is correlated with a worse prognosis in many malignancies7891011. Moreover, Fang et al.[12]reported that an elevated NLR is significantly associated with a worse disease-free and overall survival in OSCC patients. "
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    • "Although evidence on the prognostic role of the NLR in breast cancer has been relatively scarce (Azab et al, 2012, 2013; Noh et al, 2013; Dirican et al, 2014; Nakano et al, 2014; Yao et al, 2014), our robust results add valuable evidence that the NLR is also an adverse prognostic indicator in breast cancer. An earlier study in breast cancer patients, which stratified the NLR according to quartiles, reported that mortality was higher in the highest NLR quartile but closely similar among the lower three quartiles, suggesting a threshold effect (Azab et al, 2012). In our study, although the risk of mortality increased substantially with each NLR quintile in univariable analysis, the observation that this trend was attenuated after multivariable adjustment seems to suggest that the association between the NLR and mortality in breast cancer may not be entirely linear. "
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    Full-text · Article · May 2015 · British Journal of Cancer
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